Back pain: What every woman needs to know

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My wedding was a few weeks away, and I was determined to burn some serious last-minute calories in Spinning class. I felt great until the next morning, when any movement that required me to use my back (even routine things like brushing my teeth) caused lightning bolts of pain to shoot down my left leg. I knew this wasn’t run-of-the-mill workout soreness. The pain was so severe that my doctor ordered an MRI (magnetic resonance imaging); the scan revealed that a bulging disk in my lower back was pressing on one of my sciatic nerves, the ones that start at the spine and snake down each leg. The physician recommended physical therapy, but because I couldn’t begin until after my honeymoon, I downed lots of over-the-counter pain relievers. They got me through the big day and our bicycle trip around France, but over the next year, I ended up trying almost every nonsurgical remedy I thought was safe, only to get worse. At 32, I felt ancient.

It turns out that women often experience back pain, mild or severe, for the first time as young adults, says Daveed Frazier, M.D., a spine-disorders specialist and assistant clinical professor of orthopedic surgery at Columbia University College of Physicians & Surgeons in New York City. And 80 percent of Americans will have an aching back at some point, according to the American Academy of Orthopedic Surgeons in Rosemont, Illinois. I’d had minor pain on and off for years, and if I’d known then what I know now, I’d have taken it more seriously. Happily, most people with back pain can find relief when they know where to look. That’s where I come in: In my quest to feel better, which ultimately included eight specialists, 71 physical therapy sessions and surgery, I’ve learned more than I cared to. So with the help of top back experts, I’ve come up with six crucial pieces of advice that can help anyone with back pain get back on track. Get ready to put pain behind you.

Take care of yourself first

Even if your back really hurts, pursue at-home treatment for several days, says Jeffrey Goldstein, M.D., a spine surgeon at New York University Hospital for Joint Diseases in New York City. This advice is especially helpful for first-time pain caused by everyday injuries such as lifting something heavy or making an unexpected twisting move. Those aches are often muscle and ligament strains and sprains, which respond well to these do-it-yourself fixes: Take it easy, but don’t stay in bed longer than 24 hours; your muscles will only get weaker, says SELF contributing editor Lisa Callahan, M.D., medical director of the Women’s Sports Medicine Center at the Hospital for Special Surgery in New York City. Instead, return to gentle activities and light stretching (but no twisting moves) as soon as you can. You can also take a nonsteroidal anti-inflammatory drug such as ibuprofen or naprosyn and use ice to reduce swelling (15 minutes on, 45 minutes off); if cold packs don’t seem to help, try applying heat (20 minutes on, 20 minutes off). This simple approach usually cures about 90 percent of cases, Dr. Frazier says. But there are a few instances where do-it-yourself treatment is the wrong approach: Go to the emergency room if your pain is accompanied by high fever, chills or nausea (which may indicate a serious infection); do the same if you have a loss of bladder control or sharp pain in the lower leg (both of which point to severe nerve damage).

Still aching after a week? Seek help

If you’re not noticeably better after seven days, there’s probably something more going on than a garden-variety strain, and it’s worth getting evaluated. General practitioners can and do treat back-pain symptoms effectively, but you may want to see a specialist. If you have shooting pain like sciatica, start with a neurologist. If your pain is more generalized, consider a physiatrist (an M.D. expert in nonsurgical treatment of musculoskeletal problems), an orthopedist (a bone and joint specialist) or a chiropractor. One note about chiros: They do more than spinal manipulation, which a report in the Annals of Internal Medicine found only moderately effective for back pain. Many chiropractors use other techniques, such as exercise and deep-tissue massage to eliminate fibrous adhesions within the muscles. Whomever you choose, try to get recommendations from physical and massage therapists in your area. They tend to see patients after treatment and hear all the stories, the good and the bad.The doctor will check for a more severe muscle injury (such as a strain from overexertion), the most probable cause of back pain in young women, Dr. Callahan says, as well as for problems with a disk, the spongy water-filled shock absorber between each vertebra. One of the biggest culprits is hitting the gym (or the track or tennis court)—just as you’re supposed to.

“High-impact activity is good for your muscles, bones and heart, but not so good for your joints,” like the vertebrae in your spine, Dr. Frazier says. Over time, repeated muscle and ligament problems combined with the stress of activity can begin to damage these natural shock absorbers. (Other back busters include poor posture, wearing high heels, weight gain, pregnancy, even chronic stress.) Plus, as you age, your disks increasingly become drier, making you even more prone to injuries, says Janet Bezner, Ph.D., vice president of the American Physical Therapy Association in Alexandria, Virginia. Another big factor is weak core muscles, which can’t properly support the spine to maintain good posture. When a disk is overstressed, it may gradually bulge from between the vertebrae or it may rupture; both can put pressure on a nerve exiting the spine, which can result in leg and back pain. In my case, pedaling hard in that Spinning class wasn’t the only thing that triggered the herniated disk; it was likely a combo of years of sports (I rowed competitively), intense workouts several times a week and spending countless hours hunched over my desk.

Don’t ignore on-again, off-again pain

Some people have one hit of back pain, know what caused it and avoid trouble again. But if yours returns, even if it’s only a couple of times a year and feels no worse than before, you need to take action. “Back pain is like a smoke alarm,” says Drew DeMann, D.C., a spine specialist and director of services for Manhattan Spine and Sports Therapy in New York City. “If you turn off the alarm and go back to sleep, it’s dangerous—you’re still in a smoky house.” As soon as you feel better, you’ll probably do all the things that caused the pain in the first place, which can set you up for more problems later.

That’s exactly the mistake many women make. Two years before my fateful Spinning incident, I experienced my first episode of sciatica while training with a crew team. My doctor prescribed anti-inflammatory meds and assured me that they’d do the trick. They did, and after a week, I went back to my usual fitness routine, though I gave up rowing. But he had never explained what could be causing the pain, so when aches flared again, I popped more ibuprofen and pushed on through. Had I known my problem had a name and that physical therapy could help it, I probably could have prevented the injury that struck before my wedding—and the surgery I eventually had to have.

Early intervention is key, says John Triano, Ph.D., director of the chiropractic division at the Texas Back Institute in Plano. If you let persistent pain go, you’ll adapt to it. That may sound like a good thing, but it can make it harder to recover: Fear of pain can trigger changes in your posture. You may begin to favor certain positions, limiting your movement and making you stiffer and weaker—the opposite of what needs to happen for you to get better.

Try physical therapy—it works wonders

Get ready for this one: Specific exercises may be all you need to ease your back pain—even if working out caused the problem in the first place. Why? Weakness is just as bad for your back as overly strenuous activity, Dr. Callahan says. Physical therapy can teach you how to build muscle safely. “We work to strengthen the abs, back and hips,” says Connie Hauser, a physical therapist at Kentucky Physical Therapy in Barbourville. “If we can get them strong and flexible, most people can avoid more back injuries.” (Once you’re well on your way to getting better, you may want to add “back school” to your recovery plan. These programs, which physical therapists, chiropractors and hospitals offer, specifically teach how to prevent injury from daily activities, like hauling 25-pound grocery bags upstairs.)

Sometimes, though, major pain and stiffness can make exercise nearly impossible. In that case, your physical therapist will likely recommend massage first, says Hauser. When researchers from the University of Washington at Seattle recently reviewed dozens of studies comparing massage, acupuncture and chiropractic spinal manipulation, regular massage topped the list for relieving back pain, and it may be cheaper in the long run. But the relaxing treatment does have its limits: Massage simply loosens muscles and relieves pain enough so that you can begin physical therapy. Sorry, you’ll have to work out eventually.

A combination of twice-weekly physical therapy and once-a-week massage sessions for three months worked for me. After my therapy ended, I kept up my own back strengtheners for the next three months. In fact, I was feeling so much better that I went cross-country skiing. Can’t keep me down—or so I thought.

Keep fighting long-lasting pain

I was close, so close, to 100 percent better, and then I wiped out on a patch of ice. Six months of hard work went down with that fall. This was a brand-new injury, and I couldn’t move without fire shooting from my waist to the toes of my left foot. Sitting through dinner was impossible, but so was standing. My only relief was lying on the floor, in a hot bath or in bed, expertly propped with pillows; then I only throbbed.

I returned to my back doctor, who prescribed stronger drugs and injections of anti-inflammatories into my spine. The physician also told me to do more physical therapy and to lose weight (which was pretty difficult, considering I could barely move my left leg). Nothing worked. Still, I followed the advice for another six months, only to get stiffer, weaker and more depressed. I should have demanded another MRI immediately, but I was too exhausted from the pain to think clearly. Then one day, I happened to see my internist, who said, “You’re 32, you can’t put on your own socks, and you think that’s OK?!” Until then, I’d been resigned to suffering.

Here’s what I didn’t know then: “You can be pretty sure an approach isn’t going to work if there’s no improvement after three or four treatments,” Bezner says. If you’re not getting better at all, it’s always good to get a second opinion. A different type of specialist may see the problem—and possible solution—from a whole new angle. “The back is an enigma, and it can be hard to pinpoint the cause of pain,” Dr. Goldstein says. It can take a number of false starts to get an accurate diagnosis and just as many to find the treatment that brings relief. Keep trying. If you started with drug therapy only, try physical therapy; if physical therapy alone isn’t working, consider adding massage or medication.

Remember this: You will feel better

I asked my physical therapist for a few doctors’ names and she referred me to Dr. Frazier. He ordered an MRI, which revealed a herniated disk so severe, another minor injury could have partly paralyzed me. After getting a second opinion, I scheduled surgery for the day after my first wedding anniversary. It was my last option.

More than 800,000 Americans have back operations every year, but surgery may be necessary in less than 1 percent of back-pain cases, according to a study in the journal Medical Clinics of North America. On the other hand, research shows that, when appropriate, up to 90 percent of diskectomy operations are successful, according to the North American Spine Society in LaGrange, Illinois. During surgery, the bulging part of the disk is removed, leaving the healthy section between the vertebrae intact. Guess what? It worked for me.

It’s been more than three years since my surgery, and aside from the occasional minor twinge, my pain is gone. I still have a small bit of numbness in my left toes, a result of the months of pressure on my sciatic nerve, but it doesn’t cause any trouble other than the occasional stub. I’ve skied (and fallen!), raked and stooped in my garden and hauled heavy loads of laundry. I’m now pregnant with a very large, very active baby boy, and my back is still in remarkably good shape. My final words of wisdom for you: Don’t assume back pain is going to take over your life forever. In my case, that will be my new son’s job.